Health care problems and solutions in politics

[rjs330]

Explain what you mean by "deductible"
OB

Things that Medicare doesn't cover. It appears they don't cover a bunch of things and don't cover the full costs of prescriptions. What do people who can't afford those costs do in your country?

 

[MorkandMindy]

That's not unreasonable. But I'm not sure why you need insurance companies as managers. Seems to me that middlemen just add to the premium. It has to be cheaper if non-profit regional insurance funds directly handle claims and pay providers. Do providers bill Tricare, or do they bill the contracted insurance carrier? As a provider myself, I know it would be much easier if every patient's bill was sent to a single payer, rather than having to deal with multiple different insurers.

The complexity of allocating costs means hospitals may have more staff doing billing than the number of beds they have.

I've encountered problems with the fine distinction between a test needed for diagnosis and possible treatment which Medicaid covers, and screening which it doesn't, and that is something nobody seemed at all clear on. But there's also the division of costs around the myriad of charges between a certain percentage to Medicare, to Medicare Supplemental Insurance, and the patient.

After attempting to bill Medicare, Medicaid or the supplemental, some charges may be refused and after trying three times they then, fortunately can just be dumped on the patient to deal with, otherwise there would be twice as many billing staff as beds.

You'll only be sure what the correct final bill is when you get to heaven.

 

[rjs330]

Are they custom-made digital hearing aids from an independent audiologist after a hearing test?

My mom passed away, so I don't know the details. I do know she went to an audiologist and had to order them. They were not cheap to be sure. I want to say about 800 each. They were not like thousands each.

 

[GodLovesCats]

Mark, that reminds me of my dad. He complained about getting a CAT scan, "to see if I need a PET scan." The results would not be available for 2 weeks. The PET scan result was he had progressed to Stage 4. All I could think was he should have had the PET scan the day after his colonoscopy. That kind of thing could be caused by health insurance for other people, although I will never know if Aetna was guilty.

 

[GodLovesCats]

My mom passed away, so I don't know the details. I do know she went to an audiologist and had to order them. They were not cheap to be sure. I want to say about 800 each. They were not like thousands each.

Here in the United States, $800 is almost nothing for a hearing aid. If a client does not pay $3,000, it will be totally useless.

 

[Occams Barber]

Things that Medicare doesn't cover. It appears they don't cover a bunch of things and don't cover the full costs of prescriptions. What do people who can't afford those costs do in your country?

I answered part of your question in Post #62:

I had to look "deductible" up in Google. Turns out it's US specific terminology for what I know as an 'excess'

North American
noun: deductible; plural noun: deductibles
the part of an insurance claim to be paid by the insured; an excess.
Short answer - there is no "deductible". There may sometimes be a 'gap payment' - a small payment to cover the difference between the doctor's/specialist's fee and the Medicare refund they receive. Many doctor's forgo this particularly for older or low income clients. There is no 'gap payment' for hospital services.

For pharmaceutical products there is an annual 'safety net'. When a person and/or his family's prescription costs reach $1550 in a calendar year the cost per scrip drops to $6.50 for the rest of the year. If they spend more than an additional $390 in that year the cost drops to zero.
Pharmaceutical Benefits Scheme (PBS) | 5. The Safety Net Scheme
OB

 

[98cwitr]

Some pregnant women need abortions for medical reasons. For everyone else, I'm totally against allowing health insurance companies to cover abortions.

Incorrect. They need proper care or at worse, an emergency c-section. I challenge you to show me any example, or case, where the only option to save a woman's life is to kill her unborn child apart from removing the child from the womb and giving him or her medical care to do no harm to his or her life.

 

[GodLovesCats]

Incorrect. They need proper care or at worse, an emergency c-section. I challenge you to show me any example, or case, where the only option to save a woman's life is to kill her unborn child apart from removing the child from the womb and giving him or her medical care to do no harm to his or her life.

As a moderator, I would expect you to know those answers are in the Abortion Debate section. Do I need to repeat them in a thread that is not about the ethics of killing fetuses?

The abortion issue only came up because health insurance companies pay for it.

 

[98cwitr]

As a moderator, I would expect you to know those answers are in the Abortion Debate section. Do I need to repeat them in a thread that is not about the ethics of killing fetuses?

The abortion issue only came up because health insurance companies pay for it.

I am referring to the OP, which is dealing with healthcare problems and solutions. Abortion does happen to cross that divide.

They shouldn't be paying for it. It should be abolished.

 

[GodLovesCats]

Health care problems definitely include unnecessary abortions being paid for. Unfortunately, abortions for medical reasons do happen. That is why I underlined "elective" in my post about maternal health care.

Ectopic pregnancies kill both the mother and embryo. There is NO way to move the embryo to her uterus, according to gynecologists and obestrictians who do NOT work for Planned Parenthood. I can post a link if you don't believe me.

 

[rjs330]

I answered part of your question in Post #62:


For pharmaceutical products there is an annual 'safety net'. When a person and/or his family's prescription costs reach $1550 in a calendar year the cost per scrip drops to $6.50 for the rest of the year. If they spend more than an additional $390 in that year the cost drops to zero.
Pharmaceutical Benefits Scheme (PBS) | 5. The Safety Net Scheme
OB

I guess copay would be a better way of asking than deductable. What do you do with people who don't have the $1500 to cover the medicine? Saying some doctors just wave it doesn't really help. We have a lot of doctors that wave costs here too and hospitals that wave or dismiss costs here.

So what happens to those that can't afford the medicine and the cost isn't waved?

 

[rjs330]

Health care problems definitely include unnecessary abortions being paid for. Unfortunately, abortions for medical reasons do happen. That is why I underlined "elective" in my post about maternal health care.

Ectopic pregnancies kill both the mother and embryo. There is NO way to move the embryo to her uterus, according to gynecologists and obestrictians who do NOT work for Planned Parenthood. I can post a link if you don't believe me.

Not to get into an abortion debate. There are cases albiet a tiny minority where the mothers life is in danger during pregnancy where an abortion is necessary to save her life. And I have no problem with that being covered. Any other reasons no.

 

[GodLovesCats]

I guess copay would be a better way of asking than deductable. What do you do with people who don't have the $1500 to cover the medicine? Saying some doctors just wave it doesn't really help. We have a lot of doctors that wave costs here too and hospitals that wave or dismiss costs here.

So what happens to those that can't afford the medicine and the cost isn't waved?

Actually a copay and deductible are totally different. A deductibe is how much money you must pay for a treatment to be insured for it. For example, I could be insured for a certain medication after spending a $600 deductible. A copay is what you pay a receptionist for a therapy or doctor appointment.

 

[rjs330]

We've talked a bit about getting things paid for and coverages, but I think we've missed the lager elephant in the room which is the cost of medical care. It appears our costs outstrip the costs of care elsewhere. Some of that I think is due to universal healthcare. Medicare is a good example. It does NOT cover the actual costs of the treatment. And if everyone was on it the costs would be lower because the government would control the pricing.

My question is, is it possible to bring down costs without going to a system where government controls the prices? Right now doctors can charge $150 for an office visit. Medicare pays for 80% of that.

That's just a standard "I don't feel good" visit.

 

[Speedwell]

Incorrect. They need proper care or at worse, an emergency c-section. I challenge you to show me any example, or case, where the only option to save a woman's life is to kill her unborn child apart from removing the child from the womb and giving him or her medical care to do no harm to his or her life.

That only applies post-viability.

 

[stevil]

Some pregnant women need abortions for medical reasons. For everyone else, I'm totally against allowing health insurance companies to cover abortions.

I understand that according to your own morals or religious beliefs you don't accept that people should be allowed to have abortions or that insurance/ health care providers should support abortions, but do you believe that your own morals should be forced onto everyone in society? Do you believe the government should force a particular morality onto everyone?

 

[Silverback]

That's not unreasonable. But I'm not sure why you need insurance companies as managers. Seems to me that middlemen just add to the premium. It has to be cheaper if non-profit regional insurance funds directly handle claims and pay providers. Do providers bill Tricare, or do they bill the contracted insurance carrier? As a provider myself, I know it would be much easier if every patient's bill was sent to a single payer, rather than having to deal with multiple different insurers.

I believe the bill is sent to the regional manager, I am not really involved at that end. When Tricare started in the early 1990's, I believe it was much more centralized. The regional carrier is probably more experienced in running an insurance company, If the military tried to manage it, you would have a total turnover of personnel every three years.

 

[GodLovesCats]

RJ, the biggest flaw in the ACA (for me personally) is it does not require insurance companies to keep the same prices for extended release verions of drugs when someone needs to switch. Mom could pay just $5 for 3 months of a regular medication but I must take the XR version and it costs hundreds of dollars even though they are exactly the same drug. The only way I can get it is free from the manufacturer, based on my low income level by filling out a form the doctors gives me every year. And this is a drug I can't live a single day without. At the bare minimum there needs to be a very low price cap on prescription drugs.

 

[Occams Barber]

I guess copay would be a better way of asking than deductable. What do you do with people who don't have the $1500 to cover the medicine? Saying some doctors just wave it doesn't really help. We have a lot of doctors that wave costs here too and hospitals that wave or dismiss costs here.

So what happens to those that can't afford the medicine and the cost isn't waved?

As far as pharmaceutical products go, as far as I know, there is no specific safety net for the safety net. There is however a safety net for out of hospital medical expenses generally. There are a couple of thresholds related to co-payment expenses ($470) or total out of pocket expenses ($2133 or $680 for those who receive a Family Payment). It gets complicated here since there are a number of payments within the Social Security system which interact with these safety nets.
Medicare Safety Nets - What are the thresholds - Australian Government Department of Human Services
OB

 

[GodLovesCats]

I understand that according to your own morals or religious beliefs you don't accept that people should be allowed to have abortions or that insurance/health care providers should support abortions, but do you believe that your own morals should be forced onto everyone in society? Do you believe the government should force a particular morality onto everyone?

I clearly stated I oppose letting health insurance companies cover elective abortions, but if the mom's life is in danger, they must be exempt from this rule. I also was clear that all maternal care must be covered. Nobody should be forced to support or oppose abortions. Did you really think I implied that?